HI Lurchie
Sorry to hear you are having such a tough time of this. I understand this is not something you would expect at the the age of 22
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My questions are:Can anybody explain to me briefly my problems? The surgeon and his team I saw were most unhelpful and I got made to feel a nuisance if I'm honest, I feel as if I'm the boy who cried wolf everywhere I go.
Sorry to hear this - you need to be able to communicate openly with the surgeon as he holds so much responsibility if you do undergo a procedure. I would be quite assertive about this. If you feel like you are not being listened to or are not getting the information you require don't pussy-foot around. Complain! Remember they are there to provide you with a service for which you are paying for - directly or indirectly. To be fair surgeons aren't always the best communicators - their moments of brilliance occur when the patient is complete out to it! Dealing with conscious patients isn't always their forte. So if they aren't being helpful let them know this - they don't always realise.
It sounds like you may have some disposition to disc disease, whether congenital or genetic. Having three levels of of faulty discs would suggest this.
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At L5/S1 there is a left paracentral disc protrusion and a left lateral component. This is causing compression of both the lateral recesses more so on the left side, affecting the transmitting S1 nerve roots bilaterally. This is also causing foraminal stenosis on the left with compression of the exiting left L5 nerve root. This is also causing about 50% spinal canal stenosis at this level.
It is all about the disc putting pressure on the nerve roots where they exit. As it is affecting the S1 nerve roots on both sides and with the narrowing (stenosis within the canal at this level, this means there isn't much room to move. Are you getting symptoms in both legs or just left? So you get mechanical compression of the nerve roots and this irritates the delicate nerve structures causing inflammation - which in turn causes more compression and pain. The tissue responsible for the pain on the whole is one of the wrappings around the nerves called the dura. the dura is very sensitive to pain in order to protect the nerve from harm. The nerve itself is insensitive to pain but when the nerves are compressed you get a loss of function to the area in the leg that the nerve services: muscle weakness and loss of sensation. Pins and needles are common and that is when the sensation is being affected but is still partially intact.
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Should pain meds alleviate all the pain? How can I best manage the pain? As the pain is always there even with the meds, I've tried my best to deal with it but I've reached a point where I cannot do anything as sitting longer than 5 minutes is almost impossible.
You clearly aren't coping with the pain and you are on quite a cocktail of medications. As this has been going on for 8 months now the pain has become chronic. Taking opioid preparations isn't the best at this stage but you need to get advice from a good Dr on this. Pain medication is just one avenue. It might be worth considering other ways in addtion to the medications. Cognitive Behavioral therapy - a well established psychological intervention has been shown to be helpful with managing chronic back pain. this is not to say that back pain and sciatica are psychological problems but pain and how it is managed is very amenable to sound psychological help. And pain can also be depressing and can make you aversive to activities you anticipate will make you sore.
Getting help from a pain team is often the best way to go: pain specialist, OT, PT Psychologist. From a physical therapy point of view I would be quite concerned about your difficulty with exercising as you were obviously fit before and now have really blobbed out. Not managing sitting for more than 5 mins is very restrictive so if I was your PT I would want to address these issues and support you through getting to be as active as you can manage. Loss of fitness is bad for back pain and makes matters worse.
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Are there any specific exercises I can do to assist my recovery?
Given that the pain is quite probably quite irritable I think you need to go and see someone rather than giving exs over the net. One approach that may be worth trying is a PT that uses the McKenzie method- If it isn't helpful the therapist should be able to let you know from the start or you will find out quite quickly - you should get immediate reduction in symptoms if it is helpful. However there are other approaches
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Nerve root block, is this a temporary measure?
Yes and no. The block usually consists of an anaesthetic (temporary) and a steroid (antiinflammatory that can break the irritative cycle thereby potentially being long term.)
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Discectomy - what are the risks? and what other options do I have?
Best to talk to the surgeon about discectomy risks. In addition to the risks the need to achieve some decompression is important to consider. If you have a lot of weakness and numbness then it may be the best option. If it is mainly pain and not much weakness or numbness then give your age I would definitely want to consider other options.
Actually, one effective treatment is the activation program - that is basically a full on fitness programme - there is evidence that this may reduce the problem and even reduce the need for surgery. However - as I said - you would need to get support with the pain relief side of things as this can be daunting. So the programme must be supervised and often works best with a multidisciplinary approach.
What is your line of work?
MRI in April 2010 and the report I have typed out below...
